title: The use of fractional exhaled nitric oxide in investigation of work-related cough in a hairdresser.
abstract: BACKGROUND
  Occupational and environmental factors may be a cause of nonasthmatic eosinophilic bronchitis (NAEB). The diagnosis of occupational NAEB requires evidence of sputum eosinophilia. Nevertheless, a minority of patients are not able to produce suitable sputum specimens.
  
  
  METHODS
  This case report describes a 25-year-old woman, working as a hairdresser since the age of 20 years and handling ammonium persulfate, who came under our observation for work-related rhinitis and cough.
  
  
  RESULTS
  A specific inhalation challenge with ammonium persulfate elicited dry cough, without any significant change in forced expiratory volume in 1 s (FEV(1) ). Sputum induction was unsuccessful both pre- and after specific inhalation challenge. Fractional exhaled nitric oxide (FeNO) values significantly increased after specific inhalation challenge, suggesting a diagnosis of occupational NAEB due to ammonium persulfate.
  
  
  CONCLUSIONS
  From this observation we suggest that FeNO measurement should be added to the investigation of work-related cough during specific inhalation challenge, and may be considered as an alternative to induced sputum to evaluate bronchial inflammation when sputum collection is unavailable or unsuccessful.
authors.affiliation: Allergy and Immunology Unit, Fondazione 'Salvatore Maugeri', Institute of Care and Research, Scientific Institute of Pavia, Italy. giannipalass@libero.it
authors.forename: Gianni
authors.initials: G
authors.lastname: Pala
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pignatti
authors.forename: Gianna
authors.initials: G
authors.lastname: Moscato
mesh_terms: D000328:Adult; D001249:Asthma / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D029481:Bronchitis, Chronic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D003371:Cough / Q000175:diagnosis / Q000209:etiology*; D004802:Eosinophilia / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005541:Forced Expiratory Volume; D006197:Hair; D058206:Hair Bleaching Agents / Q000633:toxicity*; D006202:Hair Dyes / Q000633:toxicity*; D006801:Humans; D009569:Nitric Oxide / Q000633:toxicity*; D016273:Occupational Exposure / Q000009:adverse effects*; D017132:Workplace
chemical_list: D058206:Hair Bleaching Agents; D006202:Hair Dyes; D009569:Nitric Oxide